Volunteer Work. Comp. Election Form. Volunteer Workers' Compensation Coverage - opers ucsc 2026

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The document is a Volunteer Waiver and Election of Workers' Compensation Coverage form for individuals providing volunteer services at the University of California, Santa Cruz (UCSC). It outlines the terms under which volunteers agree to participate, including their understanding of coverage under UCSC's Self Insured Workers' Compensation Program, a waiver of liability against the university, and the requirement to report any injuries or illnesses incurred during their volunteer service.

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How to use or fill out Volunteer Work. Comp. Election Form. Volunteer Workers' Compensation Coverage - opers ucsc

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name in the 'Name of Volunteer' field, ensuring it's typed clearly for accurate identification.
Fill in your home phone number and address to provide contact information.
Specify the UCSC Sponsored Program/Event/Activity where you will be volunteering, along with the start and end dates of your appointment.
Indicate the UCSC Department for which you will be providing services and include the name and phone number of your supervisor.
Carefully read through the 'Election of Remedy' section, confirming your understanding before signing at the bottom.
Complete the 'Waiver, Release & Indemnity' section by acknowledging your agreement to its terms with your signature and date.
Finally, ensure all required copies are distributed as indicated at the bottom of the form.

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Volunteer Work. Comp. Election Form. Volunteer Workers' Compensation Coverage - opers ucsc 2026

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